On 3 October 2015, a United States Air Force AC-130U gunship attacked the Kunduz Trauma Centre operated by Médecins Sans Frontières (MSF, or Doctors Without Borders) in the city of Kunduz, in the eponymous province in northern Afghanistan. 42 people were killed and over 30 were injured. MSF condemned the incident, calling it a deliberate breach of international humanitarian law and a war crime. It further stated that all warring parties had been notified about the hospital and its operations well in advance.Doctors Without Borders Enraged Over 'Deliberate' Kunduz Hospital Bombing. The Huffington Post, 6 October 2015.
The United States military initially said the airstrike was carried out to defend U.S. forces on the ground. Later, the United States commander in Afghanistan, General John F. Campbell, said the airstrike was requested by Afghan forces who had come under Taliban fire. Finally, Campbell said the airstrike was a U.S. decision, made in the U.S. chain of command and not requested by Afghan forces. Campbell said that the attack was "a mistake", further stating: "We would never intentionally target a protected medical facility." The USCENTCOM 15-6 report stated that General Campbell's own lack of strategic guidance and dissemination of certain Rules of Engagement were major contributing factors that led to the command and control breakdown prior to the airstrike. Anonymous sources alleged that cockpit recordings showed the AC-130 crew questioned the strike's legality.
On 7 October 2015, President Barack Obama issued an apology and announced the United States would be making condolence payments of $6,000 to the families of those killed in the airstrike. Three investigations of the incident were conducted by NATO, a joint United States-Afghan group, and the United States Department of Defense. The Department of Defense released its findings on 29 April 2016. MSF has called for an international and independent probe, saying the armed forces who carried out the airstrike cannot conduct an impartial investigation of their own actions.
Background
On 28 September 2015, Taliban militants seized the city of Kunduz, driving out government forces. After the reinforcements arrived, the Afghan army, backed by U.S. air support, began an offensive operation to regain control of the city. After several days of fighting, Afghan forces claimed to have retaken the city. However, fighting continued into October 3.
MSF had informed all warring parties of the location of its hospital complex. MSF personnel had contacted U.S. military officials as recently as 29 September to reconfirm the precise location of the hospital. Two days prior to the attack Carter Malkasian, adviser to the Joint Chiefs of Staff, emailed MSF asking if the facility had Taliban militants "holed up" inside.
A US special operations unit was nearby and communicating with the aircraft that delivered the airstrike. US special operations analysts were gathering intelligence on the hospital days before the airstrike because they believed it was being used by a Pakistani operative to coordinate Taliban activity. The Associated Press reported that the analysts had circled the hospital on their maps as they tracked the Taliban operative. General Joseph Votel headed US Special Operations Command at the time of the attack.
Attack
Médecins Sans Frontières reported that between 02:08 and 03:15 local time (UTC+04:30) on the night of 3 October, the organization's Kunduz hospital was struck by "a series of aerial bombing raids". The humanitarian organization said the hospital was "hit several times" in the course of the attack, and that the building was "partially destroyed". It further said the hospital had been "repeatedly & precisely hit" and that the attack had continued for 30 minutes after MSF staff contacted U.S. and Afghan officials. The Associated Press reported that US Special Forces were a half mile away from the hospital at the time of the attack, defending the governor of Kunduz province. Likewise, Afghan forces were a half mile away. 42 people, including doctors, staff members and patients, were killed in the attack.
Confirmation and response The U.S. military initially said there had been an airstrike in the area to defend U.S. forces on the ground, and that "there may have been collateral damage to a nearby medical facility". On 15 October NBC Nightly News reported that according to Defense Department sources, cockpit recordings from the attacking AC-130 gunship "reveal that the crew actually questioned whether the airstrike was legal".Joshua Keating, "The Doctors Without Borders Bombing Is Looking More and More Like a War Crime", Slate (16 October 2015)
U.S. and NATO Commander John F. Campbell later confirmed that a U.S. AC-130 gunship made the attack on the hospital and that it was a US decision, contrary to earlier reports that the strike had been requested by local Afghan forces under Taliban fire. He specified that the decision to use aerial fire was "made within the US chain of command". Campbell said the attack was "a mistake", and "We would never intentionally target a protected medical facility." White House spokesman Josh Earnest defended U.S. forces, saying the U.S. Department of Defense "goes to greater lengths and places a higher premium on avoiding civilian casualties" than any other military in the world, and hinted the U.S. may compensate victims and their families. U.S. President Barack Obama apologized to MSF president Joanne Liu for the incident, saying it was a mistake and was intended to target Taliban fighters. The U.S. committed to making condolence payments to the families of the victims and to help with the rebuilding of the hospital.
The Afghan Interior Ministry spokesman Sediq Sediqi confirmed an airstrike on 3 October, saying that "10–15 terrorists were hiding in the hospital" and confirming that hospital workers had been killed. The Afghan Ministry of Defense and a representative of the police chief in Kunduz also said that Taliban fighters were hiding in the hospital compound at the time of the attack, the latter claiming that they were using it as a human shield.
Médecins Sans Frontières said no Taliban fighters were in the compound. Christopher Stokes, General Director of Médecins Sans Frontières Belgium, said in a statement late 4 October 2015: "MSF is disgusted by the recent statements coming from some Afghanistan government authorities justifying the attack on its hospital in Kunduz. These statements imply that Afghan and U.S. forces working together decided to raze to the ground a fully functioning hospital – with more than 180 staff and patients inside – because they claim that members of the Taliban were present. This amounts to an admission of a war crime." Stokes said, "If there was a major military operation going on there, our staff would have noticed. And that wasn't the case when the strikes occurred." On 5 October, the organization released a statement saying, "Their [U.S.] description of the attack keeps changing – from collateral damage, to a tragic incident, to now attempting to pass responsibility to the Afghanistan government.... There can be no justification for this horrible attack."
Legality Attacks on medical facilities in a non-international armed conflict are forbidden under international humanitarian law unless the facilities "are used to commit hostile acts, outside their humanitarian function". Even if armed groups are inappropriately using the facility for shelter, the rule of proportionality usually forbids such attacks because of the high potential for civilian casualties. Human Rights Watch said the laws of war require the attacking force to issue a warning, and wait a reasonable time for a response, before attacking a medical unit being misused by combatants.
At the time of the airstrikes, MSF was treating women and children and wounded combatants from both sides of the conflict. MSF estimates that of the 105 patients present at the time of the attack, three or four of the patients were wounded government combatants and approximately 20 patients were wounded Taliban. MSF General Director Christopher Stokes said, "Some public reports are circulating that the attack on our hospital could be justified because we were treating Taliban. Wounded combatants are patients under international law, and must be free from attack and treated without discrimination. Medical staff should never be punished or attacked for providing treatment to wounded combatants." Furthermore the hospital had a strictly enforced "NO WEAPONS" policy.
Article 11 of Additional Protocol II of the 1949 Geneva Conventions protects hospitals in a non-international armed conflict (which the NATO war in Afghanistan was since 19 June 2002). However, the U.S. is not a party to Protocol II and there is no mention of precautionary measures within the treaty unlike its Protocol I counterpart. Former International Criminal Tribunal prosecutor M. Cherif Bassiouni suggested that the attack could be prosecuted as a war crime under the Conventions if the attack was intentional or if it represented gross negligence noting, "even if it were proven that the Kunduz hospital had lost that right of protection due to infiltration by Taliban, the U.S. military personnel responsible for the attack would have to prove it was a military necessity to strike that hospital", even if Taliban forces were indeed using it as a human shield, or else claim that the military was unaware of the hospital's location, risking prosecution for negligence. Nonetheless, he said it is unlikely that the case will ever be tried in an international court, because "the U.S. is unlikely to turn any of their service members over to an outside body for prosecution even after facing its own military legal system." Erna Paris speculated that concern over violation of international law may be the cause of the United States' delay in publishing its own report on the attack. She commented, "To leave MSF dangling would seriously undermine the established laws of war."
Writing about the attack, human rights lawyer Jonathan Horowitz noted of that "Under certain specific and narrowly tailored conditions, individuals can be attacked even when their actions fall short of carrying weapons or opening fire on the enemy. But this alone does not necessarily justify the attack on the hospital." He emphasized the need for an independent investigation, noting that secrecy from the US and Afghanistan would be damaging to any investigation.
Casualties Previous to 12 December when new figures were released, casualty reports listed 30 dead including 13 MSF staff (three of them doctors), ten patients, and seven burned beyond recognition and as of yet unidentified. MSF reported that six intensive care patients were burned to death in their beds, and another patient died after staff had to leave the individual on the operating table. They reported that the 12 staff killed were all Afghan nationals, and that all three of their international staff members who were present survived. A review of the incident released on 7 November by MSF reported that some medical staff were decapitated and lost limbs to shrapnel and others were shot from the air as they tried to flee the burning building.
On 12 December, MSF released a new report following an "exhaustive investigation [that] included combing through the rubble of the hospital to find further human remains, interviewing family members of missing victims and crosschecking with other hospitals." The new figure for the number of deaths is "at least 42 people", including 14 staff members, 24 patients and four relatives of patients.
Hospital evacuation and shutdown